Healthcare Provider Details

I. General information

NPI: 1962159053
Provider Name (Legal Business Name): PHILLIP HUNTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BROADWAY STE 100
EL CAJON CA
92021-4899
US

IV. Provider business mailing address

1000 BROADWAY
EL CAJON CA
92021-7417
US

V. Phone/Fax

Practice location:
  • Phone: 619-977-7898
  • Fax:
Mailing address:
  • Phone: 619-977-7898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: